1972121218 NPI number — CENTIA HEALTH LLC

Table of content: (NPI 1972121218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972121218 NPI number — CENTIA HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTIA HEALTH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTIA HEALTH LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972121218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11225 N 28TH DR STE D220B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85029-5697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-518-1025
Provider Business Mailing Address Fax Number:
623-666-6655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11225 N 28TH DR STE D220B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85029-5697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-518-1025
Provider Business Practice Location Address Fax Number:
623-666-6655
Provider Enumeration Date:
07/13/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHOYINKA
Authorized Official First Name:
SOSUNMOLU
Authorized Official Middle Name:
OPEYEMI
Authorized Official Title or Position:
FOUNDER, CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
236-842-4328

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 550 . This is a "NONE" identifier . This identifiers is of the category "OTHER".